ReviewLipoprotein(a): a genetic marker for cardiovascular disease and target for emerging therapiesCesaro, Arturoa,b; Schiavo, Alessandraa,b; Moscarella, Elisabettaa,b; Coletta, Silvioa,b; Conte, Matteoa,b; Gragnano, Felicea,b; Fimiani, Fabioc,d; Monda, Emanueleb,c; Caiazza, Martinad; Limongelli, Giuseppea,c,d; D’Erasmo, Laurae; Riccio, Carmineb; Arca, Marcelloe; Calabrò, Paoloa,bAuthor Information aDepartment of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Naples bDivision of Clinical Cardiology, A.O.R.N. ‘Sant’Anna e San Sebastiano’, Caserta cDivision of Cardiology dInherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Monaldi Hospital, Naples eDepartment of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy Correspondence to Paolo Calabrò, Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Via F. Palasciano - Caserta 81100, Italy Tel: +39 0823 232395; fax: +39 0823 232395; e-mail: [email protected] Received 18 April, 2020 Revised 15 June, 2020 Accepted 29 June, 2020 Journal of Cardiovascular Medicine: March 2021 - Volume 22 - Issue 3 - p 151-161 doi: 10.2459/JCM.0000000000001077 Buy Metrics Abstract Lipoprotein(a) [Lp(a)] is an established cardiovascular risk factor, and growing evidence indicates its causal association with atherosclerotic disease because of the proatherogenic low-density lipoprotein (LDL)-like properties and the prothrombotic plasminogen-like activity of apolipoprotein(a) [apo(a)]. As genetics significantly influences its plasma concentration, Lp(a) is considered an inherited risk factor of atherosclerotic cardiovascular disease (ASCVD), especially in young individuals. Moreover, it has been suggested that elevated Lp(a) may significantly contribute to residual cardiovascular risk in patients with coronary artery disease and optimal LDL-C levels. Nonetheless, the fascinating hypothesis that lowering Lp(a) could reduce the risk of cardiovascular events – in primary or secondary prevention – still needs to be demonstrated by randomized clinical trials. To date, no specific Lp(a)-lowering agent has been approved for reducing the lipoprotein levels, and current lipid-lowering drugs have limited effects. In the future, emerging therapies targeting Lp(a) may offer the possibility to further investigate the relation between Lp(a) levels and cardiovascular outcomes in randomized controlled trials, ultimately leading to a new era in cardiovascular prevention. In this review, we aim to provide an updated overview of current evidence on Lp(a) as well as currently investigated therapeutic strategies that specifically address the reduction of the lipoprotein. © 2020 Italian Federation of Cardiology - I.F.C. All rights reserved.